Specific senerio bareback question.

Jun 16, 2010

Dear Dr. Bob. You're probably tired of these questions and I've searched for information but find little to address my (and others) specific case. Of course I like bareback sex (bottom). That's why I'm now poz. (I also thought I was careful and picky.. a lot of good that did). Anyway, now that I'm on meds (Truvada and Isentress), with good numbers and undetectable for a year. Can you really tell me what are the risks to have bareback sex. My questions are:

1. Do the meds I'm on act as PEP and lower my risk of re-infection.

2. How great is the risk of re-infection if my partner is also on meds and undetectable.

I know you feel there is some risk, but life in general is all about risk/reward. We take a risk every time we drive our cars or fly in a plane, but we do it because the rewards outweigh the risks.

Thanks for listening.

Response from Dr. Frascino

Hi,

Assuming we didn't have to worry about HIV, other STDS and unwanted pregnancies, I'm quite confident everyone would prefer bareback sex compared to suiting up in latex before diving into the love canal! Unfortunately that is not reality. We do need to worry about HIV reinfection, other STDs and unwanted pregnancies. (Okay, okay, I know you in particular don't have to worry about getting preggers, but others reading this forum might!) HIV reinfection is real and documented. We don't know how often it occurs, as it's difficult to document. It seems to occur more frequently early in the course of HIV infection. STDs, on the other hand, can occur anytime. Many STDs can cause increased HIV replication despite effective combination antiretroviral therapy (cART).

Responding to your specific questions:

1. Yes, theoretically being on effective cART would decrease the risk of HIV transmission. However, cART would not completely eliminate the risk. For instance, if your positively charged barebacking partner's virus was already resistant to medications you were taking, it's theoretically possible you could acquire his different highly resistant strain.

2. Unfortunately there is no way to measure the risk in hypothetical situations like the one you propose.

Finally, you are correct: Only you can decide exactly how much risk you are willing to accept. I, for one, would never take such a risk. I will also remind you of your experience in becoming virally enhanced: "I also thought I was careful and picky . . . a lot of good that did" . . . "I'm now poz."

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